Form 5500 · Employee benefit plan · ST CHARLES, MO
RX SYSTEMS, INC
The filing calls this plan RX SYSTEMS, INC. GROUP HEALTH PLAN.
Public Form 5500 records show how RX SYSTEMS, INC of ST CHARLES, MO, a manufacturing employer, structures its employee benefits. Its broker of record is BLACK GOULD & ASSOC. Coverage is written through CIGNA HEALTH AND LIFE INSURANCE COMPANY and 2 other carriers. The plan's most recent policy period ended in February.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 43-1174040 · plan 502 · plan year 2023, filed Oct 11, 2024
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How this plan is funded
Fully insured as reported
The filing reports medical coverage through an insurance contract on Schedule A, and no money paid for benefits by the plan itself.
Benefits declared on this filing
Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.
Where a line has more than one insured contract, the carrier and the covered figure are the largest contract's by premium. The contracts are not added up: a pharmacy carve-out and the medical carrier beside it cover the same people.
Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.
Plan brief
Schedule A lists 4 insured contracts covering health, dental, vision, life and disability; the largest, with CIGNA HEALTH AND LIFE INSURANCE COMPANY, covers 159 people.
Reported premium across the insured contracts is $627,819, with $76,139 in disclosed broker commissions — about 12% of premium.
The health contract's policy period ended in February, while at least one ancillary line's policy period ended in September. The plan is on a split renewal cycle.
BLACK GOULD & ASSOC is the broker of record on 3 of the 4 contracts; the rest name a different broker or none.
3 carriers appear on the filing, including CIGNA HEALTH AND LIFE INSURANCE COMPANY, EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA and SUN LIFE ASSURANCE COMPANY OF CANADA. CIGNA HEALTH AND LIFE INSURANCE COMPANY writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY | Health | 159 | Feb 29, 2024 | $325,742 | $36,663 |
| EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA | Health, Dental, Vision, Life, Disability | 227 | Nov 1, 2023 | $260,949 | $34,848 |
| EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA | Health, Vision, Life, Disability | 58 | Jan 1, 2024 | $35,198 | $4,265 |
| SUN LIFE ASSURANCE COMPANY OF CANADA | Dental | 28 | Oct 1, 2023 | $5,930 | $363 |
Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.
Administrator and service providers
The plan administrator is from line 3a of the main form. We publish company names only.
Reported to OSHA
Reported to OSHA for 2025: 250 employees, 12 recordable cases, 53 days away from work.
Source: OSHA Injury Tracking Application establishment data, 2025.
Other plans filed by this employer
How this plan compares
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